Is an antidepressant indicated?
The decision to treat a patient with antidepressants should be based on the following:
Severity of symptoms and ability to identify target symptoms Impairment of functioning Patient’s view of medication Not necessarily the specific diagnosis
.

cardiac patients
May be useful for:
Patients where prompt response is critical Determining compliance and metabolic availability
.g. e.Indications for serum levels
Unequivocally useful for:
Patients who are not responding to usual doses Patients who are at increased risk for toxicity.

. There are two important observations that contribute to this rationale.How Antidepressants Work
Most of the important clinical actions of antidepressant drugs cannot be fully accounted for on the basis of “synaptic pharmacology”.

. Drugs of abuse require repeated administration to produce tolerance and physical dependence.How Antidepressants Work
Many drugs require long term administration to be effective.

not within the synapse. That is.
.How Antidepressants Work
Clinical effects would appear to result from the slow onset adaptive changes that occur within neurons. activation of intraneuronal messenger pathway and regulation of neural gene expression play a central role. (drug-induced neural plasticity).

.
Chronic:
Down regulation of the post-synaptic receptors Alteration of second messenger systems Alteration of protein synthesis.“Synaptic Pharmacology”
of antidepressants
Acute:
Block reuptake or degradation of monoamines and post-synaptic alpha-1 receptor.